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1796 Learning Curve Could Affect the Surgical Outcome of Radical Hysterectomy in Cervical Cancer
S224
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM)
Interventions: This retrospective study included patients with early stage cervical cancer (Ia1 » IIa2) who were treated with radical hysterectomy from May 2006 to April 2018. Measurements and Main Results: Learning curves of each groups showed two distinct phases. The minimal cases required to achieve surgical improvement were 16 in ARH, 14 in LRH, and 15 in RRH. Progression-free survival and overall survival were not different between 3 groups (p=0.556 and p=0.273, respectively). But when the groups were stratified by the phases of the learning curves, the patients included in early phase showed poor PFS in RRH (p=0.043). Conclusion: The learning curve could significantly affect the oncologic outcome in robotic-assisted radical hysterectomy. Enough experience is necessary to improve surgical outcome in RRH. Further, a prospective randomized study regarding sufficient surgical competence is necessary for elaborate analysis of feasibility of minimally invasive radical hysterectomy.
1:30 PM: STATION I 1757 Applicability of Two Venous Thromboembolism Risk Assessment Models in Gynecologic Surgical Patients Guo T,1,* Liu C,2 Zhang Z2. 1Beijing Chao-yang Hosipital, Beijing, China; 2 Gynaecology and Obstetrics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China *Corresponding author. Study Objective: The aim of this study was to examine the applicability of the Caprini risk assessment model and gynecologic Caprini risk assessment model for postoperative venous thromboembolism risk assessment in gynecologic surgical patients and make a comparison between the two risk assessment models. Design: A database of a randomized controlled trial was employed. Scores of Caprini and gynecologic Caprini risk assessment model were calculated for each patient. Patients were categorized into four risk level groups according to scores of risk assessment models. Setting: N/A Patients or Participants: N/A Interventions: N/A Measurements and Main Results: A total of 800 patients were included. The overall incidence of venous thromboembolism was 5.8%. By Caprini risk assessment model, no patient was at very low risk, 4.3% were at low risk, 44.4% were at moderate risk, and 51.4% were at high risk. The venous thromboembolism incidence of the low, moderate, and high risk group were 2.9%, 2.3%, and 9.0%, respectively. Spearman’s rank correlation coefficient was 0.500 (p=0.667). 98.5% of patients with the malignant disease were categorized into the highest risk group. By gynecologic Caprini risk assessment model, 7.8% of the patients were at low risk, 28.0% were at moderate risk, 32.0% were at high risk, and 32.3% were at very high risk. The venous thromboembolism incidence of the low, moderate, high, and very high risk group was 0.0%, 1.2%, 5.1%, and 11.6%, respectively. Spearman’s rank correlation coefficient was 1.000 (p<0.01). Conclusion: Gynecologic Caprini risk assessment model was suitable for venous thromboembolism risk assessment for gynecologic surgical patients. Current Caprini risk assessment model could not be applied to gynecologic surgical patients.
Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION J 1796 Learning Curve Could Affect the Surgical Outcome of Radical Hysterectomy in Cervical Cancer Kim S,1,* Song JY,2 Lee JK,3 Lee NW3. 1Obstetrics & Gynecolo, Korea University College of Medicine, Seoul, Korea, Republic of (South); 2Korea University College of Medicine, Seoul, Korea, Democratic People’s Republic of (North); 3Korea University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: Minimally invasive surgery has become essential technology in field of gynecologic malignancies including cervical cancer. We reviewed our experience and evaluated the results of radical hysterectomy in patients with early stage cervical cancer. Design: Retrospective analysis. Setting: Ergonomics. Patients or Participants: This retrospective study included patients with early stage cervical cancer (Ia1 »IIa2) who were treated with radical hysterectomy from May 2006 to April 2018.
Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION K 2126 Perioperative Outcomes of Combined Gynecologic Oncology and Urogynecologic Surgeries Fan KW,1,* Shu MK,2 Eddib A,3 Tyson C4. 1Minimally Invasive Advanced Pelvic Floor Surgery Fellowship, Millard Fillmore Suburban Hospital, Buffalo, NY; 2University at Buffalo, Buffalo, NY; 3Minimally Invasive Advanced Pelvic Floor Surgery Fellowship, Millard Fillmore Suburban Hospital, Williamsville, NY; 4Applied Healthcare Research Management (AHRM) Inc., Buffalo, NY *Corresponding author. Study Objective: To compare perioperative outcomes of patients undergoing standard oncology staging versus combined oncology staging and urogynecologic procedures for pelvic floor dysfunction repair. Design: A retrospective cohort study of two gynecologic oncology patients groups who underwent robotic assisted surgical staging versus surgical staging with concomitant pelvic floor repair. Setting: Many women diagnosed with a gynecologic malignancy may have comorbid urogynecologic conditions including pelvic organ prolapse and/or urinary incontinence. Despite a significant prevalence of symptomatic pelvic floor disorders among oncologic patients, few of these patients undergo concomitant pelvic floor procedures. Literature examining the perioperative impact of combining surgeries is currently lacking. Patients or Participants: 29 women were identified and controls (n = 14) were matched to combined cases (n = 15). Interventions: Surgical staging defined as robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pelvic floor procedures include: laparoscopic uterosacral ligament suspension, Moschowitz culdoplasty, transobturator sling, and vaginal repair. Measurements and Main Results: Both groups had similar mean robotic console time, (178 minutes vs 160 minutes, p = 0.15), however combined procedure cases had increased total operative time compared to controls, (301 minutes vs 210 minutes p < 0.0001). Concurrent cases had increased blood loss estimated by absolute change in hemoglobin (-2.34g/dL vs -1.71g/dL, p = 0.043). Additional urogynecologic procedure increased risk of discharge with an indwelling urinary catheter (76.9% vs 0%, p < 0.0001). Total pain requirements were similar between the two groups (35 MME versus 23 MME, p = 0.46). Postoperative complications were similar between the two groups defined by hospital revisits comparing cases to controls (14.3% vs 13.3%, p = 1). Conclusion: Combined case surgery for oncologic staging and urogynecologic pelvic floor repair is a well tolerated combination procedure. Increased total operative time for combined cases is expected, with statistically significant risk for postoperative acute urinary retention typical for urogynecologic procedures.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM)
Interventions: This retrospective study included patients with early stage cervical cancer (Ia1 » IIa2) who were treated with radical hysterectomy from May 2006 to April 2018. Measurements and Main Results: Learning curves of each groups showed two distinct phases. The minimal cases required to achieve surgical improvement were 16 in ARH, 14 in LRH, and 15 in RRH. Progression-free survival and overall survival were not different between 3 groups (p=0.556 and p=0.273, respectively). But when the groups were stratified by the phases of the learning curves, the patients included in early phase showed poor PFS in RRH (p=0.043). Conclusion: The learning curve could significantly affect the oncologic outcome in robotic-assisted radical hysterectomy. Enough experience is necessary to improve surgical outcome in RRH. Further, a prospective randomized study regarding sufficient surgical competence is necessary for elaborate analysis of feasibility of minimally invasive radical hysterectomy.
1:30 PM: STATION I 1757 Applicability of Two Venous Thromboembolism Risk Assessment Models in Gynecologic Surgical Patients Guo T,1,* Liu C,2 Zhang Z2. 1Beijing Chao-yang Hosipital, Beijing, China; 2 Gynaecology and Obstetrics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China *Corresponding author. Study Objective: The aim of this study was to examine the applicability of the Caprini risk assessment model and gynecologic Caprini risk assessment model for postoperative venous thromboembolism risk assessment in gynecologic surgical patients and make a comparison between the two risk assessment models. Design: A database of a randomized controlled trial was employed. Scores of Caprini and gynecologic Caprini risk assessment model were calculated for each patient. Patients were categorized into four risk level groups according to scores of risk assessment models. Setting: N/A Patients or Participants: N/A Interventions: N/A Measurements and Main Results: A total of 800 patients were included. The overall incidence of venous thromboembolism was 5.8%. By Caprini risk assessment model, no patient was at very low risk, 4.3% were at low risk, 44.4% were at moderate risk, and 51.4% were at high risk. The venous thromboembolism incidence of the low, moderate, and high risk group were 2.9%, 2.3%, and 9.0%, respectively. Spearman’s rank correlation coefficient was 0.500 (p=0.667). 98.5% of patients with the malignant disease were categorized into the highest risk group. By gynecologic Caprini risk assessment model, 7.8% of the patients were at low risk, 28.0% were at moderate risk, 32.0% were at high risk, and 32.3% were at very high risk. The venous thromboembolism incidence of the low, moderate, high, and very high risk group was 0.0%, 1.2%, 5.1%, and 11.6%, respectively. Spearman’s rank correlation coefficient was 1.000 (p<0.01). Conclusion: Gynecologic Caprini risk assessment model was suitable for venous thromboembolism risk assessment for gynecologic surgical patients. Current Caprini risk assessment model could not be applied to gynecologic surgical patients.
Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION J 1796 Learning Curve Could Affect the Surgical Outcome of Radical Hysterectomy in Cervical Cancer Kim S,1,* Song JY,2 Lee JK,3 Lee NW3. 1Obstetrics & Gynecolo, Korea University College of Medicine, Seoul, Korea, Republic of (South); 2Korea University College of Medicine, Seoul, Korea, Democratic People’s Republic of (North); 3Korea University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: Minimally invasive surgery has become essential technology in field of gynecologic malignancies including cervical cancer. We reviewed our experience and evaluated the results of radical hysterectomy in patients with early stage cervical cancer. Design: Retrospective analysis. Setting: Ergonomics. Patients or Participants: This retrospective study included patients with early stage cervical cancer (Ia1 »IIa2) who were treated with radical hysterectomy from May 2006 to April 2018.
Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION K 2126 Perioperative Outcomes of Combined Gynecologic Oncology and Urogynecologic Surgeries Fan KW,1,* Shu MK,2 Eddib A,3 Tyson C4. 1Minimally Invasive Advanced Pelvic Floor Surgery Fellowship, Millard Fillmore Suburban Hospital, Buffalo, NY; 2University at Buffalo, Buffalo, NY; 3Minimally Invasive Advanced Pelvic Floor Surgery Fellowship, Millard Fillmore Suburban Hospital, Williamsville, NY; 4Applied Healthcare Research Management (AHRM) Inc., Buffalo, NY *Corresponding author. Study Objective: To compare perioperative outcomes of patients undergoing standard oncology staging versus combined oncology staging and urogynecologic procedures for pelvic floor dysfunction repair. Design: A retrospective cohort study of two gynecologic oncology patients groups who underwent robotic assisted surgical staging versus surgical staging with concomitant pelvic floor repair. Setting: Many women diagnosed with a gynecologic malignancy may have comorbid urogynecologic conditions including pelvic organ prolapse and/or urinary incontinence. Despite a significant prevalence of symptomatic pelvic floor disorders among oncologic patients, few of these patients undergo concomitant pelvic floor procedures. Literature examining the perioperative impact of combining surgeries is currently lacking. Patients or Participants: 29 women were identified and controls (n = 14) were matched to combined cases (n = 15). Interventions: Surgical staging defined as robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pelvic floor procedures include: laparoscopic uterosacral ligament suspension, Moschowitz culdoplasty, transobturator sling, and vaginal repair. Measurements and Main Results: Both groups had similar mean robotic console time, (178 minutes vs 160 minutes, p = 0.15), however combined procedure cases had increased total operative time compared to controls, (301 minutes vs 210 minutes p < 0.0001). Concurrent cases had increased blood loss estimated by absolute change in hemoglobin (-2.34g/dL vs -1.71g/dL, p = 0.043). Additional urogynecologic procedure increased risk of discharge with an indwelling urinary catheter (76.9% vs 0%, p < 0.0001). Total pain requirements were similar between the two groups (35 MME versus 23 MME, p = 0.46). Postoperative complications were similar between the two groups defined by hospital revisits comparing cases to controls (14.3% vs 13.3%, p = 1). Conclusion: Combined case surgery for oncologic staging and urogynecologic pelvic floor repair is a well tolerated combination procedure. Increased total operative time for combined cases is expected, with statistically significant risk for postoperative acute urinary retention typical for urogynecologic procedures.